WORLD AIDS DAY
______
1 DECEMBER 2016
HANDS UP FOR #HIVPREVENTION
WORLD AIDS DAY 2016: ……………………………………………………………………………………………………………………………………………………………………………………. NATIONAL & LUBOMBO COMMEMORATION Acknowledgements
Ministry of Health Swaziland National AIDS Programme National Emergency Response Council on HIV/AIDS University Research Co., LLC United Nations Programme on HIV/AIDS World Health Organisation Lubombo Regional Health Management Team Royal Swaziland Sugar Corporation Bantwana SASO PSHAAC Sebenta Compassionate Swaziland World Vision Operation Hope Swaziland His Majesty’s Correctional Services - Big Bend Tabankulu Nazarene Compassionate Ministries Environmental health Ministry of Education PSI Swaziland Healthcare Workers SWADE AMMICCAL Social Welfare Royal Swaziland Police Services Kudvumisa Joyful Hearts Siphilile Organisation SWANEPHA Media Houses Ubombo Sugar Limited Maloma Colliery Limited Cabrini Ministries Good Shepherd Hospital Community & Religious Leaders Communities
The printing of this publication was supported by the United States President Emergency Plan for AIDS Relief (PEPFAR) through Centers for Disease Control and Prevention (CDC), under the terms of Cooperative Agreement number 1U2GGH001399, managed by University Research Co., LLC (URC). The opinions expressed are those of the authors and do not reflect the views of CDC or the United States Government. Table of Contents
World AIDS Message 2016– UNAIDS ……………………………………………………………………………………………………………………………………. 1
HIV/AIDS Milestones in Swaziland ………………………………………………………………………………………………………………………………………… 2
2016 World AIDS Hands Up Campaign ………………………………………………………………………………………………………………………………… 3-4
World AIDS Campaign: Planning for Heightened Impact ...……………………………………………………………………………………………. 5
2016 World AIDS National Launch ……...………………………………………………………………………………………………………………………………… 6
World AIDS Commemoration Activities ……………………………………………………………………………………………………………………………….. 7
National World AIDS Day: “Hands Up for #HIVPrevention” ……………………………………………………………………………………………. 8-9
Regional World AIDS Day: Reaching out to Sithobelweni Inkundla ……………………………………………………………………………….. 10-11
Facility World AIDS Day: Tabankulu Estate celebrates as a community…………………………………………………………………………. 12
His Majesty’s Correctional Services, Big Bend: Police & Inmates involved in HIV Prevention ……………………………………. 13
Private Sector World AIDS Days: Royal Swaziland Sugar Corporation Departmental Commemoration …………………. 14-15
Private Sector World AIDS Day: Ubombo Sugar Commemoration for Seasonal Workers ………………………………………….. 16
Mining Sector World AIDS Day: Maloma Colliery Limited engages Miners on HIV prevention ……………………………….. 17
World AIDS Corporate Indaba & Wellness Day ………………………………………………………………………………………………………………….. 18
HIV Engagement Forums: Males & the Youth in Lubombo ………………………………………………………………………………………………. 19-22
Lessons Learnt from World AIDS Campaigns ……………………………………………………………………………………………………………………… 23 WORLD AIDS MESSAGE 2016 - UNAIDS
Today, we commemorate World AIDS Day—we stand in solidarity with the 78 million people who have become infected with HIV and remember the 35 million who have died from AIDS-related illnesses since the first cases of HIV were reported. The world has committed to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. We are seeing that countries are getting on the Fast-Track—more than 18 million people are on life-saving HIV treatment and country after country is on track to virtually eliminate HIV transmission from mother to child. We are winning against the AIDS epidemic, but we are not seeing progress everywhere. The number of new HIV infections is not declining among adults, with young women particularly at risk of becoming infected with HIV. We know that for girls in sub-Saharan Africa, the transition to adulthood is a particularly dangerous time. Young women are facing a triple threat: a high risk of HIV infection, low rates of HIV testing and poor adherence to HIV treatment. Co-infections of people living with HIV, such as tuberculosis (TB), cervical cancer and hepatitis C, are at risk of putting the 2020 target of fewer than 500 000 AIDS-related deaths out of reach. TB caused about a third of AIDS-related deaths in 2015, while women living with HIV are at four to five times greater risk of developing cervical cancer. Taking AIDS out of isolation remains an imperative if the world is to reach the 2020 target. With access to treatment, people living with HIV are living longer. Investing in treatment is paying off, but people older than 50 who are living with HIV, including people who are on treatment, are at increased risk of developing age-associated non- communicable diseases, affecting HIV disease progression. AIDS is not over, but it can be if we tailor the response to individual needs at particular times in life. Whatever our individual situation may be, we all need access to the tools to protect us from HIV and to access antiretroviral medicines should we need them. A life-cycle approach to HIV that finds solutions for everyone at every stage of life can address the complexities of HIV. Risks and challenges change as people go through life, highlighting the need to adapt HIV prevention and treatment strate- gies from birth to old age. The success we have achieved so far gives us hope for the future, but as we look ahead we must remember not to be compla- cent. We cannot stop now. This is the time to move forward together to ensure that all children start their lives free from HIV, that young people and adults grow up and stay free from HIV and that treatment becomes more accessible so that everyone stays AIDS-free.
Michel Sidibé, Executive Director of UNAIDS, Under-Secretary-General of the United Nations
1 HIV/AIDS MILESTONES IN SWAZILAND
No one ever imagined that the country would make it to where it is currently from the day the first HIV case was report- ed. Like any disease epidemic that has struck a country, Government through the Ministry of Health and other partners join forces to reduce the burden. Swaziland for one has come up with interventions, made mistakes, and some remarka- ble contributions towards fighting HIV /AIDS. It is safe to assume that to-date the milestones are notable and have served as lessons learned as the fight continues. Below are some highlights of the milestones over the years.
YEAR MILESTONE
1986 The first HIV case was reported in Swaziland
1987 The Swaziland National AIDS Programme was established to respond to the HIV epidemic
1990’S The Swaziland National AIDS programme was restricted
1995 Thulasizwe Hani Dlamini was the first Swazi to publicly declare his status
1999 King Mswati III declared AIDS a national disaster
2000 HIV prevalence within pregnant women increased to over one in three
The National Emergency Response Council on HIV/AIDS (NERCHA) was established to coordinate and facilitate the national multi-sectoral 2001 response to HIV/AIDS, while the Ministry of Health and Social Welfare (MOHSW) was to implement activities
- A programme that provides free ART in the country started 2003 - The first Voluntary Counselling and Testing centre was opened at the Mbabane Government Hospital
2004 A Joint Review committee was formed to review the National Strategic Plan (NSP) for 2000-2005
The VCT computer system that was used in Mbabane was shut down for unknown reasons in April. This saw the introduction of facility 2005 files with hand written patient information and small books for the patients The development of the Swaziland National Strategic Framework (NSF) for HIV and AIDS 2009-2014 was commissioned by the Government 2008 - 2009 of Swaziland in collaboration with other stakeholders involved in the implementation of the National Multi-sectoral Strategic Framework on HIV/AID September 2009
- The highest prevalence in the world as it was estimated that over 25% of adults from 15 – 29 were living with HIV 2009 - The USA and Swaziland signed the Swaziland Partnership Framework on HIV and AIDS for 2009- 2013
2 2016 WORLD AIDS ‘Hands Up’ CAMPAIGN
2016 Theme Target Audience For the past 5 years globally, the focus was on ‘getting to zero’. The Hands Up campaign therefore explored different aspects of UNAIDS had crafted the theme, “Getting to Zero new infections, HIV prevention and how they relate to specific groups of people HIV related deaths and stigma & discrimination” which was such as: used from year 2011-2015. Adolescent girls and young women Key populations This year the UNAIDS switched focus, which normally involves Pregnant Women only health practitioners, to include the public in the fight Men and Male youth PLHIV against the spread of HIV. The 2016 theme “Hands up for #HIVPrevention”, invites the public to contribute and commit WAC Pillars towards HIV prevention interventions. The guiding pillars for this year’s World AIDS Campaign in- cluded: It has been noted that the decline in new HIV infections among Delaying sexual debut adults has stalled. The UNAIDS Prevention Gap Report shows Condom Use that worldwide an estimated 1.9 million adults have become Male circumcision infected with HIV every year for at least the past five years and Reduction of óff-the-cuff’ sex Partner reduction that the number of new HIV infections is rising in some regions. PrEP and PEP The report shows that HIV prevention efforts must be reinvigor- PMTCT ated if the world is to stay on the Fast-Track to ending the AIDS HIV Testing Test and Start epidemic by 2030. Eliminating HIV related stigma and discrimination
Country specific reasons behind the theme include: Campaign Approach Fear of the virus has reduced as people now live longer A number of approaches were used during this campaign that People are more afraid of pregnancies than HIV infection. helped reach out to the targeted audience. Some of these includ- Stigma still remains an issue therefore people have prob- ed holding focus group discussions to help explore different HIV lems with seeking/getting adequate healthcare or treat- prevention aspects for specific groups. Secondly, the public was ment. offered a chance to suggest ways that could contribute towards There is still a need to promote messaging against further HIV prevention through writing an intervention in the palm of HIV transmission by the already diagnosed. their hands. After a messages was crafted on the hand, a pic-
ture was taken or a video shot then uploaded on social media.
3 4 WORLD AIDS Campaign: Planning for Heightened Impact
Over the years it has been proven that adequate planning is necessary assist with developing an activity calendar, to ensure full support from to carry out a successful campaign. Therefore to ensure that the the regional HIV/AIDS partners coordination team and two avoid World AIDS campaign was a success, planning meetings were held at having to activities planned on the same day. The activities were then national and regional levels. Also noted from previous activities, mapped out according to partner, planned activity and target audi- strong collaboration is key for mobilization of resources. ence. This process assisted with making sure that every target audi- ence was assigned an activity. National Level At national level the lead HIV partners coordinating the planning Resources were then mobilized based on the availability of funds and meetings were NERCHA and SNAP supported by URC. The planning the representatives who were part of the planning team. As mentioned process at this level focused on promoting the 2016 theme, “Hands Up earlier, the mobilizing of representatives outside the health scope, for #HIVPrevention”; secondly, launching the World AIDS Campaign works to the organizes advantage as they would able to support the nationally; thirdly, crafting messages to be used in line with the activities with their resources. Consider the Ministry of Education, theme; finally, supporting regional activities and budgeting. NER- they were able to support these activities by mobilizing young people CHA had planned to support all the 4 regional activities. The dates for for performances and sometimes availing classrooms to be used for the activities were as follows: cooking or hosting the VIP representatives. Manzini– 1st December As a team the programme was drafted, with close consideration of the Hhohho– 12th November community and national protocols. This can be a daunting task as it Lubombo - 19th November is important to please both parties. The team did not seem to be Shiselweni - 26th November daunted by this challenge as a lot of team work came into play. Com- The University Research Co., LLC (URC) manages a CDC project as munication about the guest speaker for instance came from the Prime the lead HIV partner nationally, thus collaborated with NERCHA in Minister’s office. Crowd pullers also differ per community and in this crafting the messages for the year. The messages were crafted both in case for the regional activity, a local Jericho Gospel group was identi- English and siSwati and were used in the promotional material, that fied. were produced for the activity.
Regional Level Other logistics that are considered during these meetings, include At regional level, the Lubombo planning team comprised of a larger venue set up, exhibitors, sound and stage preparations, refreshments, group which was not limited to HIV coordination partners only. The security and others. Normally a team is assigned to coordinate pro- team was mobilized by the Regional Health Management Team cess on the day. This process of assigning responsibilities helps with (RHMT) and was all based on the support that might be required to ensuring that the responsibility is carefully carried. carry out activities. The team that was mobilized included organisa- tions, public and private entities within the Lubombo region. Some of The meetings played a major role as all the activities planned were these included, education department, environmental health, private successfully carried out. It is therefore important that collaborative companies, community representatives and others. efforts and full commitment is shown towards hosting successful activities. To kick-start the meetings the planning team was requested to submit activities they were planning to hold in the region. This then would
5 2016 WORLD AIDS NATIONAL LAUNCH
After the candles were lit, HIV stakeholders raised their hands pledging to HIV prevention practices.
“On December 1, the country will join the world in commemorating World AIDS Day 2016 under the theme, Hands Up for #HIVPrevention”. This was Declared by the Minister of Health, Sibongile Ndlela-Simelane, during the official World AIDS Campaign launch, on 31st October 2016. The launch took place at Sibane Hotel.
In her remarks the Minister of Health pointed out that in the month of November, during build-up activities, under the theme, the country would be given a chance to express their views on what they thought needed to be done to strengthen HIV prevention efforts. The minister jokingly highlighted that the theme fits well with the Swazi culture, “When one needs to say something, they are expected to indicate by a show of hands,” she shared.
To mark the national launch of the campaign, a candle lighting ceremony was performed. The ceremony was led by the minister who lit the first candle. The lit candle was then used to light all other candles for all the key HIV stakeholders that were present on the day. Every time a candle was lit, the person holding the lit candle would raise a hand pledging to honour an HIV prevention practice.
“The goal is to reinvigorate the HIV preven- Minister of Health, Sibongile tion and treatment agenda towards the elimi- Ndlela-Simelane , Khanya Mabuza, NERCHA Executive nation of new infections and ending AIDS as Director & Muhle Dlamini a public health threat by 2022.” SNAP Programme Manager during the candle lighting - Khanya Mabuza, NERCHA Executive Director ceremony.
“There is a need to provide adolescent girls and young women with access to education and real options to protect them-
selves from HIV. We also need to provide key populations with full access to services delivered with dignity and respect.
Every child can be born free of HIV from their mothers and cannot only survive but thrive.”
-Tim Rwabuhemba, UNAIDS Country Coordinator
6 WORLD AIDS Commemoration Activities
In 2016, a number of activities were held as build up activities leading to the main commemoration of World AIDS Day. In this publication, the focus will be on some of the activities that took place in the Lubombo region.
Much can be learnt from these activities which could help with informing planning and implementation of activities yet to come in the coming years. These include some notable achievements, practises and even downfalls that may affected the success of an event.
Lubombo alone is a large region, with 11 tinkundlas. Every year the regional commemoration of World AIDS Day changes among the tinkundlas found in the region. In 2015, the commemoration was held at Lomahasha Inkundla, which has 4 communities under it. In 2016, the regional commemoration was a Sithobela, with 3 communi- ties, Luhlanyeni, Mamisa and Nkonjwa.
This did not mean though that the other communities were left out. With the strong collaboration with Lubombo partners the whole region was well covered with build- up activities. These activities targeted faith based organisations, private sector, public sector, imiphakatsi, schools and many others. Below is list of some of the activities that took place:
Maloma Mines Tabankulu WAD RSSC Male Indaba RSSC WAD Commemorations Focus Group Discussions Ubombo Sugar Limited WAD Male HIV Indaba Public Sector Lubombo WAD at Sithobela His Majesty’s Correctional Services Big Bend WAD
Other Activities: Hhohho WAD Shiselweni WAD National WAD at Mankayane Male HIV Indaba for Corporates
7 NATIONAL WORLD AIDS DAY : “HANDS UP FOR #HIVPREVENTION”
World AIDS Day was first declared by World Health Organisation and the United Nations General Assembly in 1988, designated to take place on December 1 every year. World AIDS Day is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, and mourning those who have died of the disease. Government and health officials, non-governmental organizations and individuals around the world observe the day, often with education on AIDS prevention and control.
World AIDS Day is one of the eight official global public health campaigns marked by the World Health Organization (WHO), along with World Health Day, World Blood Donor Day, World Immunization Week, World Tuberculosis Day, World No Tobacco Day, World Ma- laria Day and World Hepatitis Day.
The Event On the 1st of December 2016, the country gathered at Mankaya- ne to commemorate World AIDS Day. The national commemo- ration had the town of Mankayane come alive as thousands from all corners of the country gathered. The event began with a march led by the armed forces accompanied with harmonious “PEPFAR this year has a budget of $63 million, just over E880,000,000, that sounds of the trumpet. The march consisted of hundreds of supports critical activities in testing, diagnosis, and treatment for people people from different organizations from around the country. living with HIV/AIDS and other The town of Mankayane came alive as they paraded across the opportunistic infections, such as tuberculosis.” town and drew in more people to the celebrations of the day. - Lisa Peterson, American Ambassador to Swaziland On the day an estimated 2000 people gathered at the Mankaya- ne Sports Ground. Attendance The event was graced by the presences of senior public figures. Some of whom included His Excellency, the Deputy Prime Min- ister Senator Paul Dlamini who was representing His Excellency the Right Honourable Prime Minister, Dr. Sibusiso Barnabas Dlamini; Minister of Health, Sibongile Ndlela-Simelane; UN “The power to end HIV and AIDS does not lie with a single individual, with a Resident Coordinator, Israel Dessalegne, United States of Amer- single organisation, or government structure. When we leverage the unique ica Ambassador to Swaziland, Lisa Peterson; IPPF Director Gen- skills that we all bring to the table, we will reach our goal of ending AIDS both eral, Tewodros Melesse. Amongst this fleet of delegates were in Swaziland and the world. This power is ours and the time to act is now. If we work together as Obama says, ‘Yes, we can!’, then we can do it.” Country Heads and Directors of Organisations. - Tewodros Melesse, IPPF Director General to Swaziland
8 Activities The program for the day had a number of activities to keep the crowds well entertained, active and most importantly in a posi- tion to learn from what was presented. The first activity after the march was aerobics, which got the crowd excited and motivated. Shortly after, there were intermission breaks from the speeches, where there were edutainment sessions. These ranged from, songs, poetry, drama and dance. Services Determined to reach out to the numbers present health services were provided. Services available included information stalls where the public could be engaged at an individual level on health issues, HIV testing and other medical screening services. The Ministry’s programmes and private health organizations came in their numbers to offer these health services. Services that were also available were health services, which included HIV testing, NCD screening, TB screening, and many others.
9 Regional World AIDS DAY: Reaching out to Sithobelweni Inkundla
After so many months of dealing with a drought, it seems the World AIDS Campaigns brought a lot of blessings into the country, rain. The major activities took place on wet rainy days. One would expect that this then would result in the activities being postponed, however for the Lubombo region, it was reason to celebrate. pausing a danger to anyone who crosses. As a result less people would On the 19th of November 2016, the region hosted its regional com- be present at the event compared to the high numbers that were ex- memoration for World AIDS Day at Sithobela. The morning, started pected from the three communities under the Sithobela Inkundla with heavy showers accustomed with thunder, and the team had al- (Luhlanyeni, Nkonjwa and Mamisa). What a sigh of relief it was when ready assembled at Sithobela Police Station which was the starting the tents provided for the public were seen full with people. A total of point for the march. The moment the band played its signature tune, 824 people that were recorded attended the event. it seemed the crowds were no longer bothered by the rain as the In a matter of an hour the community of Sithobela was already paint- number of people in the march kept growing as the march paraded ed yellow, with t-shirts provided by URC through PEPFAR funding, around Sithobela. that were branded with the theme “Hands Up For #HIVPrevention”. It was a scary moment for the HIV Lubombo Coordination team as The programme was designed in a manner that provides the attends the organizers, fear was that no one would attend the event due to the with sufficient HIV prevention messages. Whether it was a speech, rains. In settings like Sithobela the small communities are normally traditional dancing, song or short drama skit performed an HIV mes- divided by rivers. With the heavy rains, the rivers were overflowing sage was conveyed.
10 Regional World AIDS DAY: Reaching out to Sithobelweni Inkundla
Also available on the day were information stalls where the attendees were able to access information on health topics in depth. The infor- mation stalls also had available brochures both in siSwati and English for the public to take to read at their personal time.
After all the health talks , health services were brought closer for the commu- nity to access services. The types of services included, HIV testing, NCDs screening and many other services.
Despite the heavy showers on the day the event was a success. Noting from the numbers recorded despite the wet cold weather. The coordination of the event also showed that the event was well planned as the team was able to
11 Facility World AIDS Day: Tabankulu Estate Seasonal Workers
PARTICIPANT GROUP # PER GROUP
Male Adults 30
Female Adults 38
Youth Males - 11 Females- 21
Total 100
As early as 5am, Tabankulu was ready to start the day and commemorate disaggregated according to youth, adult males and women groups. The World AIDS Day. This event started of with a walk from Tabankulu Estate discussion topics focused on HIV prevention, simplifying the 90-90-90 con- main entrance, Maphiveni, to Tabankulu Stadium. The walk counted as one cept, Test & Start and benefits of the strategy and finally TB Infection Pre- of the longest walks when compared to the other build-up activities in the vention and Control (IPC). region. Fortunately it served as no burden to Tabankulu residents, as they Succeeding the informative do a lot of walking as a good health practice. dialogues with the different The event took place on the 26th of November 2016. After hosting a successful groups question and answer event last year and noting the impact, the regional HIV/ AIDS partners went sessions were conducted a step further and hosted an even bigger event. This was in line with words where participants were echoed by the Tabankulu Estate, Human Resource that they would host awarded for correctly re- World AIDS activities yearly. Stakeholders present included: URC, PSI, sponding to health ques- Mhlume Member of Parliament and Siyakudvumisa. tions. The available promo- tional materials with key Tabankulu clinic sister welcomed all who were present and highlighted messages motivated the participants to be attentive and assisted them with objectives of event which were in line with the theme, “Hands Up for gaining more knowledge on HIV issues. #HIVPrevention”. The objectives for the event focused on: With all that the attendants had learnt, health services were availed to all Sensitizing the public on importance of HIV prevention that were moved to access them. Services provided included HIV testing and Empowering communities to jointly fight against HIV infections CD4 monitoring and an information stall manned by URC. Promoting Test & Start strategy Promoting the reduction of stigma and discrimination Mhlume Member of Parliament also addressed the community members and thanked all stakeholders present. He then urged the Ministry of Health It is exciting to note that with the planned dialogues most of these objectives (MOH) to continue sensitizing the public on HIV matters not only during were met. This was through the dialogues conducted as the community, WAD activities but also on other occasions, tirelessly. majority of whom were seasonal workers, was engaged. The attendants were
12 His Majesty’s Correctional Services, Big Bend: Police & Inmates involved in HIV Prevention
On the 29th of November 2016, His Majesty’s Correctional Services, Big Bend hosted its World AIDS commemoration. The correctional services felt it was important that they too celebrate the day and raise awareness for the benefit of the armed forces and prisoners. Special focus was on the prisoners as they are not fully exposed to awareness activities. On the day about 400 prisoners and 50 officers were reached.
The Correctional had planned a number of health educational activities. To start off the day as early as 5.30am there was a march led by the correctional band, from Matata to the Correctional Centre. The activities planned were aimed at promoting health seeking be- haviour. One particular activity of interest was the poem presented by an inmate. In his poem he mentioned the importance of ending the HIV epidemic, especially since it has taken the lives of thousands. He highlighted that the only way it could be stopped is if the nation could take full responsibility. This was inline with the Hands Up Campaign which seeks for the commitment of the public towards ending HIV.
The event was graced by the presence of the Commissioner General, Dr K Ndlovu , Direc- tor Health Care Services, Dr S Magagula and URC Country Director, Dr S Haumba who delivered speeches. The speeches also in support of the theme, were insightful and encour- aged all to act in the fight against HIV.
Key Highlighted Points:
Test & Start Strategy
90-90-90 UNAIDS strategy
Ten Campaign Pillars (pg 6)
Viral Load
13 Royal Swaziland Sugar Corporation: Private Sector Departmental Commemoration
The first World AIDS Day was held in 1988. tors, commonly referred to as ‘Champions’. This The commemoration of this day since its activity took place at Mhlume, on the 1st of inception has provided a platform for November 2016. many other activities aimed at reduc- A large attendance of 200 champions from ing HIV. the 4 mills (Mhlume, Tabankulu, Simunye The Royal Swaziland Sugar Corpora- and Big Bend) were present on the day. The tion Limited (RSSC), located in the north large group was oriented by URC on Test & -eastern Lowveld and is one of the largest Start, HIV testing and Counselling, male engage- companies in Swaziland. The company employs ment and Voluntary Medical Male Circumcision over 3 500 people and produces two-thirds of the (VMMC). The session with the group was very interactive country’s sugar and a significant quantity of ethanol. as the peer educators showed interest in the topics discussed.
RSSC values its employees, hence provides health care at two site based clin- In the closing remarks, the RSSC group clinics manager presented on the ics, centrally managed by a Medical Service Manager. The emphasis is on available health care services offered by RSSC. Further emphasized was the primary health care and prevention of diseases such as HIV and TB. need to embrace the new Test & Start strategy to reduce mortality and mor- bidity. Alluding to RSSC values, according to the message by the Acting MD, RSSC has proactively planned Health and Wellness Service delivery by setting up By the end of the event, the champions were able to understand the im- structures such as HIV Testing and Counselling, Voluntary Testing and portance of adopting a safe lifestyle to be free from HIV infection. Men also Counselling, rolling out ARVs, conducting TB screening and strengthening seemed to take a lot of interest in taking the lead to ensure that they are the companies support system of wellness Champions. Already of note, the tested for HIV as well as their families. acting MD added, “I believe that the above factors are the reasons why we Departmental Commemoration have seen significant improvement in the prevalence of HIV from 37.1% in Stretching out to ensure maximum reach to all the RSSC employees, the team 2002, 38.1% in 2007 to 34.1% in 2012 and tuberculosis (TB) from a long term organized a departmental WAD commemoration. This activity consisted of average of 22 to less than 10 cases, as well as in reduction of AIDS-related ### department activities. It was held on the 29th of November 2016, be- deaths in our workplace. As outlined in our Health and Wellness Policy, we tween the four mill sites (Mhlume, Tabankulu, Simunye and Big Bend) and have the co-responsibility to minimize the impact of HIV on our business, the Headquarters. employees and community. Concluding he pledged that RSSC will continue to provide health and wellness services that contribute to ‘Getting to Zero’. The same set up was followed with all the activities.. The employees would convene in one departmental area per site. The days proceedings remained Champions Commemoration the same for each department., each starting off with a candle lighting cere- Recognizing HIV/AIDS as a strategic business issue, RSSC manages it at the mony. Short remarks were included to serve as a reminder for commemorat- highest level in the organization. Maintaining its standard, RSSC participat- ing WAD. The Acting MD’s message which was in line with the theme en- ed in the commemoration of World AIDS Campaigns. On the 1st of Novem- couraged the employees to practice HIV prevention approaches. ber 2016, the company hosted its World AIDS campaign for its Peer Educa-
14 NERCHA was present to provide brief health talks on HIV issues. Shortly after was a session led by URC where employees pledge to HIV prevention practices.
Ideas were shared and discussed in detail, of the different ways to prevent HIV. By the end of the session it was interesting to note the number of people who had their hands up for HIV prevention..
“This theme encourages us to pursue specifically targeted
approaches to HIV prevention based on how they address the
needs of specific groups of women, men and people living with
HIV. The occasion also provides an opportunity for employees to
express their views and opinions on what needs to be done to
strengthen HIV prevention efforts and make the“ AIDS” free
society a reality by 2030. ”
-RSSC
15 UBOMBO SUGAR: Seasonal Workers
Ubombo Sugar Limited Swaziland is situated adjacent the Usuthu River in the south east of the country, is one of three sugar producers in Swaziland whose combined total sugar output of more than 580 000 tons is marketed and distributed by the Swaziland Sugar Association (SSA). Around 40% of Ubombo’s current sugar produc- tion is refined and sold into the SACU region, with other preferential and regional markets. A major factory expansion and power co-generation project, commissioned in April 2011, allows the Ubombo operation to produce sufficient co-generated electricity from renewable resources to cater for all of its own factory, agricultural and other requirements. In addition, the operation exports power to the Swaziland national grid on a commercial basis. Ubombo holds a capacity of about 1 229 permanent employees and 1631 seasonal workers.
Ubombo Sugar considers and regards the health of its employees important therefore has medical group within the organization, called Illovo Medical Group. The group took the opportunity of hosting a World AIDS Day which would promote the importance of prevent HIV. The event was held on the 26th of November under the theme “#HIV must fall”.
The event commenced with a march from Ubombo Sugar Hospital to Maya- luka Stadium. From the early hours of morning more than hundred people had gathered at the hospital and were dressed in blue t-shirts with an HIV message, which they had received. The uniformity of the crowd led by a the Salesian band and the Ministry of Health, Sibongile Ndlela-Simelane and other delegates as they marched to Malayuka Stadium was not hard to miss. The crowds continued to grow as the march made its way to the stadium and with all the placards and banners held up the message was well presented. It is estimated that over 1 000 people attended the event.
Ubombo Sugar had engaged other private corporate companies, like Nedbank, which were reached with health messages. Their involvement
though in line with the national theme “Hands Up for #HIVprevention” was to have the companies commit to any means that will help with preventing HIV. Therefore Nedbank made a fine contribution of E 5 000, contributing towards HIV prevention services. Other companies made contributions which resulted in the success of the event.
HIV testing services were made available on the day along with information stall for the public to consult on HIV issues. It was exciting to note the num- ber of people that crowded the URC stall which was the only health infor- mation desk where the crowds cold consult on HIV related questions.
16 Maloma Colliery Limited: Mining Sector Commemoration
Maloma colliery limited is a mining company operating in the Lubombo region of Swaziland. It mines coal and is located about 60km South of Big Bend which has the Ubombo Sugar Company. The nearest communities are Lubuli and Ikhwezi in Lubombo Region and Ngudzeni, in Shiselweni Region. The company has a staff strength of about three hundred and fifty (350) with two hundred and eighty (280) of these working underground. Maloma colliery limited is a mining company operating in the Lubombo region of Swaziland. It mines coal and is located about 60km South of Big Bend which has the Ubombo Sugar Company. The nearest communities are Lubuli and Ikhwe- zi in Lubombo Region and Ngudzeni, in Shiselweni Region.
Maloma Colliery Limited recognized the impact of HIV in the country, and the Ministry of Health’s effort in curbing the menace caused by the disease. On the 22 November 201, the mining company therefore decided to join the Ministry of Health in marking this year’s World AIDS Day Commemoration themed “Hands Up for #HIVPrevention”. This event was particularly im- portant to the company as it is aware of the fact that a healthy workforce is vital to maintain production at an optimal level. An estimated 350 employees attended the event. The commemoration also focused on health education on HIV issues and The gathering provided a platform for the management of the company to with special focus on the theme, URC facilitated this process. The staff was emphasize importance of adopting a safe lifestyle to be free from HIV infec- taught on possible HIV prevention measures, clearing out any possible tion and accessing the widely available HIV testing and treatment services at myths. Another special ingredient added to the events programme was a the Mine clinic and other health facilities in the country. session on Test & Start. This session went into depth about the new initiative introduced by the Ministry of Health that anyone that test HIV positive can Present during this event for regional support was the regional lead partner now access ART early regardless of the CD4 count. University Research Co., LLC (URC), that manages the CDC SNAP/Lubombo HIV/TB project and Swaziland Business Coalition on HIV and AIDS SWABCHA in support of the activity had a mobile clinic available providing (SWABCHA). comprehensive health services on the day, for staff to access. Services that were available included TB screening, HTS, Hepatitis B test, Blood pressure The message for the day emphasized the importance of knowing HIV status and blood sugar screening. URC had set up a stall for staff to access infor- and starting treatment if HIV positive. Echoing these words was the CEO of mation and question and answer sessions were conducted to measure Maloma Colliery, Jacobs Du Plesis said, “Timely treatment, is the only hope knowledge gain during the health education session. of staying alive and healthy for anyone who has been infected with HIV or TB. He further stressed the ‘no discrimination ‘ company policy towards any The event managed to target a large audience and this was possible because staff member that openly declares their status. Concluding Du Plesis pledged of the timing. The team targeted a time that will ensure that all staff mem- continued support for all staff to access safe and quality HIV/TB care of staff bers are present, in the afternoon after work.. The Maloma Team appreciated whiled employed by the company. the success and support that went into the implementation of the activity.
17 World AIDS Corporate Indaba & Wellness Day
When planning HIV engagement activities the corporate sector in towns, are normally left out, as activities normally target out of town communities. Strengthening the impact, the 2016 campaign was well planned to make sure that no population is missed. The Ministry of Health collaborated with the University Research Co., LLC (URC) and Ncedze Properties and hosted a World AIDS Corporate Indaba & Wellness Day for Ncedze Tenants at the Mbabane Office Park. This event which was the first of its kind at Mbabane Office Park was held on the 7th of December 2017, from 12am till 7pm.
It was envisaged that through this activity the corporate world which is where most men are commonly found and the public shall be encouraged to under- go HIV testing and be linked into appropriate care as well as offered other free NCD screening and financial counselling.
Services that shall were offered included engaging men the key target audi- ence and other corporates on HIV topics, HIV testing services, TB screening, blood pressure screening and diabetes screening and other health services.
The response to the provision of health services was well received by the corporates and it was noted from the 120 people that visited the health stalls. 46 people were recorded to have tested for HIV and out of that group 6 were found to be HIV positive. Another confirmation was noted from the remarks made by the corporates about how they were appreciative of the initiative.
18 HIV Engagement Forums: Males & the Youth in Lubombo
The theme “Hands Up for #HIVPrevention” encouraged the involvement of PRIVATE SECTOR MALE INDABA everyone in the country. The Lubombo HIV Coordination Forum identified that males and the youth, especially ‘out of school youth’ needed specially On the 2nd of November 2016 the region in collaboration with the Ministry of focus to heighten their HIV prevention commitment. The best identified way to health held a Male Indaba for the Public Sector at Siteki Regional Offices. engage these students was to hold focused group discussions at the three Below are some of the issues highlighted by the 35 males, related to health, neighboring communities of Sithobelweni. These are Nkonjwa, Luhlanyeni and which were found during the discussions.
Mamisa. Some men are still reluctant to test and are not comfortable going to
The communities were disaggregated according to sex and age. The age groups hospitals/Clinics were 21-24, 25-35 and above 35 years of age. Topics that were focused on relat- It is true some men still have more than one sexual partner ing to the Key HIV issues were: Girls throw themselves at the men, particularly men driving big cars, Service Delivery it doesn’t matter if it’s their cars or not. HIV Testing MCPs, Intergenerational sex and early debut perpetrated by wives’ Condom Use reluctance to give husbands conjugal rights ART Adherence
Photo Gallery for Focus Group Discussions
19 NKONJWA
21 – 24 25 – 35 ABOVE 35 36 MALES FEMALES MALES FEMALES MALES FEMALES Attended 1 12 6 12 3 2
FINDINGS ISSUES WAY FORWARD
Hardly have such forums where they are allowed to share views on HIV issues. SERVICE The service providers are con- DELIVERY fusing us with different infor- mation.
The is an HIV testing centre in the HIV testing providers come once in a while but local clinic but young people fear there is no follow up, because they hardly come to go to do an HIV test in the Conducting of mobile HIV testing outreach pro- TESTING back to the community for re-test. clinic because they are concerned gram every 3 months. Men are reluctant to take an HIV test. with confidentiality issues as
HCWs a part of the community.
The free condoms have an odour, as a result most women don’t like the free condoms.
The condoms are placed in open public settings Let them be delivered to community peer making it hard to access them in fear of stigma. educators as central distributors of condoms. It’s not practical to break a virgin with a condom. Strengthen and capacitate community peer Condoms are well placed in local CONDOM It’s hard to use a condom in the first encounter educators. stores though they are not acces- USE unless the partner negotiates for it. Let the condoms come in variety and should sible for young people. Men don’t like to use condoms. be youth user friendly with nice messages High teenage pregnancy rate. written on it. Majority mentioned that they started having sex Provision of condoms in school toilets. at high school; High sexual activities happen amongst in school youth and without protection.
ART is initiated at Sithobelweni Don’t want to be known in the community clin- ART literacy Hospital and the local Communi- ics, they would rather collect treatment as far as Positive Living literacy ty clinic at Nkonjwa. Sphofaneni clinic, hence becomes costly. Government must make means at least to have ART Too many pills to consume. 1 dosage a day or a week. ADHERENCE Fear of Stigma. No awareness on treatment literacy.
20 MAMISA
21 – 24 25 – 35 ABOVE 35 69 MALES FEMALES MALES FEMALES MALES FEMALES Attended 8 28 6 15 2 0
FINDINGS ISSUES WAY FORWARD
HIV Programs hardly visit the community to engage them on HIV. SERVICE Last heard of it in school, DELIVERY haven’t seen any service pro- vider in the community.
The is an HIV testing centre in the local clinic but young people fear Fear to test due to fear of confidentiality. Continuous dialogues on HIV issues and to go to do an HIV test in the TESTING Haven’t seen any mobile testing service in our Testing. clinic because they are concerned community for the past 3 years. Conduct mobile HIV testing outreach. with confidentiality issues as HCWs a part of the community.
Let the Condom cans be installed outside the The free condoms have an odour, as a result most store building so that we can access them women don’t like the free condoms. even at night. The condoms are placed in open public settings Consistent open communication between Condoms are well placed in local making it hard to access them in fear of stigma. CONDOM sexual partners needs to be encouraged stores though they are not acces- Communication barrier amongst sexual part- USE Let the condoms come in variety and should sible for young people. ners. be youth user friendly with nice messages It’s not practical to break a virgin with a condom. written on it. High Teenage pregnancy rate Women empowerment sessions on condom Sexual activities are very high. negotiating skills.
Don’t want to be known in the community clin- Continuous ART literacy ics, they would rather collect treatment as far as Positive Living literacy Sphofaneni clinic, hence becomes costly. Government must make means at least to have ART ART is initiated at Sithobelweni Too many pills to consume. 1 dosage a day or a week. ADHERENCE Hospital. Fear of Stigma. With the introduction of Test & Start initiative No awareness on treatment literacy. enough time for counselling should be consid- ered.
21 LUHLANYENI
21 – 24 25 – 35 ABOVE 35 58 MALES FEMALES MALES FEMALES MALES FEMALES Attended 5 8 11 12 14 8
FINDINGS ISSUES WAY FORWARD
Hardly have such forums SERVICE where they are allowed to share DELIVERY views on HIV issues.
The distance to the Hospital and separation of ART departments from other health services becomes demotivating. HIV testing services is done at To conduct HIV testing outreach programmes TESTING HIV testing providers do come once in a while Sithobela Hospital. every 3 months. but there is no follow up because they do not regularly visit the community. Men are reluctant to test for HIV.
Ladies don’t like the free condoms, they complain of smell. Let condoms be delivered to community peer Condoms are well placed in local CONDOM The condoms are placed in open public settings educators. stores though they are not acces- USE making it hard to access them in fear of stigma. Let the condoms come in variety and should be sible for young people. High Teenage pregnancy rate. youth friendly with nice messages written on it. Men don’t like using condoms.
Division of ART department and other services is not motivating but has an element of exposing ART ART is initiated at Sithobelweni ART literacy. people. ADHERENCE Hospital. Positive Living literacy. Too many pills to consume. Fear of Stigma.
22 Lessons Learnt From World AIDS Campaigns
LESSONS FROM 2016 Conducting targeted FGDs during WACs is more effect than when conducted during the actual big events (e.g. Re- gional/National WAD)
Conducting community dialogues at communities, where groups are smaller, helps spark interest and increases attendance during the main events.
Drafting questions to be used at the stall assists with better engaging the crowd.
A clear BCC distribution plan is necessary to monitor distribution and reduce confusion.
LESSONS CONSIDERED IN 2016 LESSONS FROM 2015
Great involvement and partnerships between public, private, Role of political leaders and religious leaders influence com- non-governmental organizations and financial based organi- munity mobilization and sensitization towards health seeking zations leverages resources towards successful implementation behaviour. of community events and reduces duplication of services. WAD events still attract older age groups and other innova- Early planning and development of WAD calendar is im- tive ways are still needed to attract younger populations portant in maximizing participation and coordination of re- There is a demand for HIV testing in the general public as gional WAD events. shown by the numbers gathered at the HTC sites during Some national initiatives to engage men are done on an adhoc WAD. basis and are not sustained and yet they have a potential of
transforming and addressing social barriers to uptake of ser-
vices by men.
Involvement of public figures and socialites assists with draw- ing crowds.
Coordinated effort from partners is required which assists with reinforcing one message to the public.
Media coverage goes beyond sensitizing targeted audience at the event, instead targets a national scope.
23 University Research CO., LLC (URC)
HEAD OFFICE 3rd Floor, North Wing, Building 1 Mbabane Office Park Sozisa Road P. O. Box 1404 Mbabane H100, Swaziland
Tel: (+268) 2404 7154/56/69 Fax: (+268) 2404 7199
REGIONAL OFFICE Portion 7, Farm 182 Siteki
Tel: (+268) 2343 5896/7 Fax: (+268) 2343 5895
Website: www.urc-chs.com
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